Healthcare Provider Details

I. General information

NPI: 1750623591
Provider Name (Legal Business Name): COURTNEY RINEHOLD R.D., C.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 04/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 GLACIER RIDGE RD
FORT WAYNE IN
46845-9720
US

IV. Provider business mailing address

1607 GLACIER RIDGE RD
FORT WAYNE IN
46845-9720
US

V. Phone/Fax

Practice location:
  • Phone: 260-494-7235
  • Fax:
Mailing address:
  • Phone: 260-494-7235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37001842A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number37001842A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: